Provider Demographics
NPI:1740387158
Name:KING, JO ANN (OD)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAUPHIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-3705
Mailing Address - Country:US
Mailing Address - Phone:251-438-1153
Mailing Address - Fax:251-433-9829
Practice Address - Street 1:9 DAUPHIN ST
Practice Address - Street 2:STE 101
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-3705
Practice Address - Country:US
Practice Address - Phone:251-438-1153
Practice Address - Fax:251-433-9829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS534-TA272152W00000X
ALS-534-TA-272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1740387158OtherNPI
AL72-1394515OtherTAX ID